Non-Cochrane · intervention · PM42036699
The effectiveness of using local anesthesia with general anesthesia in pediatric dental rehabilitation: a systematic review and meta-analysis.
Ibrahim Shimaa T, Jamal Doaa Y, Alzahrani Ahmed Y, et al. · Systematic reviews · 2026 · PubMed · doi:10.1186/s13643-026-03181-2
Findings
Population Children younger than 17 years undergoing dental treatment under general anesthesia
17 findings
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Post-operative pain (yes/no) Post-operative · Operating room, pediatric dental rehabilitation under general anesthesia | OR 0.32 [0.14, 0.70] Very low Downgraded: risk of bias, imprecision 3 studies · 169 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Heart rate (bpm) Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Extraction | SMD -1.75 [-4.63, 1.13] GRADE not reported 2 studies · 128 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | End-tidal CO2 (mm Hg) Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Stainless steel crown (SSC) | SMD 0.02 [-0.32, 0.37] GRADE not reported 2 studies · 128 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | End-tidal CO2 (mm Hg) Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Rubber dam | SMD -0.26 [-0.78, 0.26] GRADE not reported 2 studies · 58 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Post-operative anxiety (Venham scale) Post-operative, after extraction · Operating room, pediatric dental rehabilitation under general anesthesia | MD -0.66 [-1.59, 0.27] Low Downgraded: imprecision 2 studies · 95 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Heart rate (bpm) Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Stainless steel crown (SSC) | SMD 0.42 [-0.10, 0.95] GRADE not reported 2 studies · 58 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Post-operative lip and/or cheek biting Post-operative (24 h; 4 to 6 h after discharge) · Operating room, pediatric dental rehabilitation under general anesthesia | OR 1.41 [0.08, 25.39] GRADE not reported 2 studies · 162 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Respiratory rate Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Pulpotomy | SMD -2.22 [-6.26, 1.81] GRADE not reported 2 studies · 128 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Heart rate (bpm) Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Pulpotomy | SMD -3.60 [-10.88, 3.68] GRADE not reported 2 studies · 128 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Respiratory rate Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Stainless steel crown (SSC) | SMD 0.04 [-0.48, 0.55] GRADE not reported 2 studies · 58 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Heart rate (bpm) Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia | SMD -1.67 [-3.46, 0.12] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 314 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | End-tidal CO2 (mm Hg) Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Pulpotomy | SMD -3.65 [-10.83, 3.53] GRADE not reported 2 studies · 128 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Respiratory rate Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Extraction | SMD -2.22 [-5.94, 1.51] GRADE not reported 2 studies · 128 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Respiratory rate Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Rubber dam clamp | SMD -0.06 [-0.58, 0.45] GRADE not reported 2 studies · 58 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | End-tidal CO2 (mm Hg) Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia · Procedure: Extraction | SMD -1.96 [-4.43, 0.52] GRADE not reported 2 studies · 128 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | End-tidal CO2 (mm Hg) Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia | SMD -1.39 [-2.55, -0.22] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 442 participants |
| Intraoperative local anesthesia (LA) during dental treatment under general anesthesia | No LA or placebo (saline) | Respiratory rate Intraoperative · Operating room, pediatric dental rehabilitation under general anesthesia | SMD -1.12 [-2.34, 0.09] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 372 participants |
Included primary studies 14
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Al-Bahlani 2001 Tooth extraction, bleeding and pain control. PMID:11697691 | 2001 | this review only | not stated | not extracted yet |
| Anand 2005 Intraligamental analgesia for post-operative pain control in children having dental extractions under general anaesthesia. PMID:15839828 | 2005 | this review only | Post-operative anxiety (Venham scale) | not extracted yet |
| Batawi 2013 Factors affecting clinical outcome following treatment of early childhood caries under general anaesthesia: a two-year follow-up. PMID:24030856 | 2014 | this review only | Heart rate (bpm); Respiratory rate; End-tidal CO2 (mm Hg) | not extracted yet |
| Coulthard 2006 Intraoperative local anaesthesia for paediatric postoperative oral surgery pain--a randomized controlled trial. PMID:17014994 | 2006 | this review only | Post-operative lip and/or cheek biting | not extracted yet |
| Jurgens 2003 Pain relief for paediatric dental chair anaesthesia: current practice in a community dental clinic. PMID:12605626 | 2003 | this review only | Post-operative pain (yes/no) | not extracted yet |
| Leong 2007 Perioperative local anaesthetic in young paediatric patients undergoing extractions under outpatient 'short-case' general anaesthesia. A… PMID:17694046 | 2007 | this review only | Post-operative anxiety (Venham scale) | not extracted yet |
| Lipp 2021 Effect of Intrapapillary Local Anesthetic on Postoperative Pain Following Dental Treatment Under General Anesthesia in Pediatric Patients. PMID:34911068 | 2021 | this review only | Post-operative pain (yes/no) | not extracted yet |
| McWilliams 2007 Assessment of early postoperative pain and haemorrhage in young children undergoing dental extractions under general anaesthesia. PMID:17683324 | 2007 | this review only | not stated | not extracted yet |
| Moness 2019 Local Anesthesia Effects on Postoperative Pain After Pediatric Oral Rehabilitation Under General Anesthesia. PMID:31171068 | 2019 | this review only | not stated | not extracted yet |
| Noble 1994 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sammons 2007 Randomized controlled trial of the intraligamental use of a local anaesthetic (lignocaine 2%) versus controls in paediatric tooth… PMID:17559458 | 2007 | this review only | not stated | not extracted yet |
| Skarda 2021 matched by author and year (probable) | NR | this review only | Post-operative pain (yes/no); Heart rate (bpm); Respiratory rate; End-tidal CO2 (mm Hg) | not extracted yet |
| Townsend 2009 The effect of local anesthetic on quality of recovery characteristics following dental rehabilitation under general anesthesia in children. PMID:20020791 | 2009 | this review only | Post-operative lip and/or cheek biting | not extracted yet |
| Watts 2009 Local anesthesia affects physiologic parameters and reduces anesthesiologist intervention in children undergoing general anesthesia for… PMID:19947137 | 2009 | this review only | Heart rate (bpm); Respiratory rate; End-tidal CO2 (mm Hg) | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants younger than 17 years having any dental treatment under general anesthesia | Children aged 2 to 17 years having extractions, restorations, crowns or pulpotomy under GA (14 studies) |
| Intervention | Any local anesthesia (type, dose, method) given during dental treatment under GA | Lidocaine/lignocaine (8), prilocaine, mepivacaine, bupivacaine, xylocaine, all with epinephrine (n=14) |
| Comparison | Placebo, no LA, or another LA prescription | No LA or saline placebo; two studies compared two active LA interventions |
| Outcomes | Post-operative pain or distress; intraoperative or post-operative bleeding; physiological parameters (heart rate, respiratory rate, end-tidal CO2); analgesic requirement | Post-operative pain, anxiety (Venham), lip and cheek biting, heart rate, respiratory rate, end-tidal CO2, bleeding, distress |
| Study designs | RCTs and non-randomized clinical trials with at least two arms | Parallel-group controlled trials (n=14) |
| Timing | Not specified | Post-operative at waking, discharge and post-discharge; intraoperative physiological monitoring |